Fluconazole

And itraconazole penetrate poorly into CSF and the former is potentially hepatotoxic and inhibits testosterone and adrenal steroids synthesis. Administration of fluconazole, a new triazole derivative can be a good alternative in view of its good CSF penetration, concentration in urine and minimal adverse reaction 4 ; . The present retrospective study was undertaken to evaluate the efficacy of fluconazole in treating neonatal systemic candidiasis. Subjects and Methods A retrospective analysis was carried out on neonates who received fluconazole for 7 days or more as the first line drug against systemic candidiasis between September 1994 to August 1995. The criteria for diagnosis of systemic candidiasis were clinical. Baxter's fluconazole is available in a premix, ready-to-use flexible container as 200mg 100ml in sodium chloride 9% injection and 400mg 200ml in sodium chloride 9% injection.

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Providers should contact the EDS Pharmacy Services Help Desk for Point-of-Service POS ; Claims Processing at 317 ; 655-3240 in the Indianapolis local area, or 1-800-577-1278, or by e-mail at INXIXPharmacy EDS for questions about what constitutes the correct unit for a drug billed to the IHCP. All efforts to help minimize the number of manufacturer disputes are appreciated. Cats have a lower ability to metabolize this drug, for example, fluconazole yeast infection!
Some of the items that can be prescribed by pharmacists participating in the "Direct supply of medicines" pilot project are: l l l Lactulose, loperamide, Dioralyte, Anusol Chlorhexidine mouthwash Menthol crystals, simple linctus, pseudoephedrine Paracetamol, ibuprofen, co-codamol Clotrimazole cream, fluconazole capsules, aciclovir for cold sores Aqueous cream, Oilatum, Conotrane, hydrocortisone cream 0.5 and 1 per cent ; Hypromellose eye-drops, fucithalmic eye-drops. Of organelles. Monocytes revealed idented, U- or Wshaped nuclei with dilated nuclear pores, vacuolated cytoplasm and plasma membrane with many protrusions and endocytic vesicles. Ghadially 14 described similar alterations of leucocytes of monocytic leukaemic patients. Lymphocytes were found with irregular hyperchromatic nuclei, mitochondria with light matrices and plasma membranes with numerous filopodia. Similar findings have been described by Komiyama et al15 in humans suffering from leukaemia. Eosinophils and basophils have altered plasma membranes, eccentric nuclei and pleomorphic granules. Eosinophilia was the most common laboratory findings in patients treated with fluconazole for the therapy of invasive mycoses7. Altered plasma cells were also observed. Their presence in the peripheral blood indicates a change in the immune system of the body. From the above discussed results, it could be concluded that, fluconazole has serious detrimental impacts on the blood cells of toads and these hazardous effects are comparable to those induced by the chemical carcinogen DMBA. Still the validation of this conclusion for human beings would require considerable further experimentation and galantamine!
Anethum graveolens L. dill ; is a sparse looking plant with feathery leaves and tiny yellow flowers. Some pharmacological effects have been reported, such as antimicrobial [1, 2], antihyperlipidaemic and antihypercholesterolaemic [3] activities. As a folk remedy, dill is considered for some gastrointestinal ailments such as flatulence, indigestion, stomachache and colic [4]. Dill fruit has an antispasmodic effect on the smooth muscles of the gastrointestinal tract [5]. On the basis of above observations, the antisecretory and mucosal protective effects of A. graveolens seed extracts were evaluated in mice. For the avoidance of doubt, the divestment businesses shall, inter alia, not include: a ; intellectual property other than intellectual property predominantly relating to the divestment businesses; the "pfizer" and "pharmacia" name and logo in any form; books and records required to be retained pursuant to any statute, rule, regulation or ordinance, provided that a purchaser shall obtain a copy of the same and shall be permitted access to the original of such books and records upon reasonable request during normal business hours; and general books of account and books of original entry that comprise the parties' or an affiliated undertaking's permanent accounting or tax records and glibenclamide, for example, fluconazole pregnancy.

They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. It is notably known whether rabeprazole soiles into fluconazole diflucan commerce and glucovance.
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Nephrology, Seth GS Medical College, 2Nephrology, PD Hinduja National Hospital and Medical Research Centre, 3Immunology, Seth GS Medical College, Mumbai, India Introduction: Diagnosing iron deficiency is rendered difficult in the presence of uremia. The inflammatory state complicates the issue. The value of the tests, in diagnosing iron deficiency, formed the basis of this enquiry. Purpose. The epidemiology, clinical manifestation, diagnosis, and management of invasive mycoses in transplant patients are described. Summary. The incidence of and mortality from invasive mycoses have increased in transplant patients. Candida and Aspergillus are the two most common fungal pathogens in this patient population. The use of immunosuppressive and myeloablative therapies and other factors increases the risk of invasive mycoses. A high index of suspicion and clinical clues are needed for the diagnosis of Candida and Aspergillus infections because reliable diagnostic techniques are not available and the patient presentation is nonspecific. Targeted prophylaxis for patients at high risk for morbidity and mortality and early, aggressive treatment using broad-spectrum antifungal agents are recommended. Prophylaxis using itraconazole reduces the risk of treatment failure due to resistant pathogens compared with fluconazole. Voriconazole might prove advantageous compared with fluconazole and itraconazole for prophylaxis because of its extended spectrum and and inderal. Top more common side effects of generic urispas may include: drowsiness dryness of mouth and throat less common side effects of generic urispas may include: blurred vision constipation difficult urination difficulty concentrating dizziness fast heartbeat headache increased sensitivity of eyes to light increased sweating nausea or vomiting nervousness stomach pain rare side effects of generic urispas may include: confusion eye pain skin rash or hives sore throat and fever top click on links below to view medicines in the relevant category men's health sildenafil citrate 25mg 50mg 100mg tadalafil 10mg 20mg finasteride generic equivalent to propecia ; 1mg women's health fluconazole 50mg dt 150mg 200mg clomiphene citrate generic equivalent to clomid ; 50mg raloxifene generic equivalent of evista ; 60mg norgestrel + ethinyl estradiol generic equivalent of ovral ; 5mg + 05mg quit smoking bupropion sr bupropion generic equivalent of zyban ; sr 150 mg pain relief celecoxib 100 mg 200 mg 400 mg carisoprodol generic equivalent of soma ; 350 mg compound soma tramadol generic equivalent of ultram ; 50 mg sr 100 mg tizanidine generic equivalent of zanaflex ; 2 mg 4 mg gastric esomeprazole generic equivalent of nexium ; 20 mg 40 mg omeprazole generic equivalent of prilosec ; 10 mg 20 mg 40 mg lansoprazole generic equivalent of prevacid ; 15 mg 30 mg anti depressants fluoxetine generic equivalent of prozac ; 10 mg 20 mg 40 mg 60 mg 80 mg citalopram generic equivalent of celexa ; 10 mg 20 mg 40 mg paroxetine generic equivalent of paxil ; 10 mg 20 mg 30 mg 40 mg venlafaxine xr generic equivalent of effexor xr ; 150 mg xr 3 5 mg xr 75 mg xr sertraline 25 mg 50 mg 100 mg antibiotic amoxicillin 250 mg 500 mg ciprofloxacin generic equivalent of cipro ; 250 mg 500 mg 500 mg od 750 mg 1000 mg sulphamethoxazole - tmp 400 80 mg 800 160 mg erythromycin generic equivalent of erythromycin ; 4% gel 250 mg 3% gel 500 mg levofloxacin generic equivalent of levaquin ; 250 mg 500 mg 750 mg migraine sumatriptan generic equivalent of imitrex ; 25 mg 50 mg 100 mg ergotamine tartarate, caffeine, belladonna, paracetamol generic equivalent of migranal ; allergy fexofenadine 120 mg 180 mg montelukast generic equivalent of singulair ; 5 mg 10 mg loratadine generic equivalent of claritin ; 10 mg cetirizine 10 mg lipid lowering agents simvastatin generic equivalent of zocor ; 5 mg 10 mg 20 mg 40 mg 80 mg atorvastatin 10 mg 20 mg 40 mg 80 mg pravastatin generic equivalent of pravachol ; 10 mg 20 mg 40 mg 80 mg blood pressure amlodipine 5 mg 5 mg 10 mg metoprolol xr generic equivalent of toprol xl ; 50 mg 100 mg metoprolol generic equivalent of lopressor ; 25 mg 50 mg 100 mg furosemide 40 mg hydrochlorothiazide generic equivalent of hydrochlorothiazide ; 1 5 mg 25 mg skin care tretinoin generic equivalent of renova ; 05% 025% anti-viral drugs acyclovir 200 mg 400 mg 800 mg quality generic drugs huge savings more than 1200 drugs customer satisfaction credit cards personal checks shipping options reshipments order tracking refund policy delivery gaurantee order cancellations quality generic drugs huge savings more than 1200 drugs customer satisfaction credit cards personal checks shipping options reshipments order tracking refund policy delivery gaurantee order cancellations - about us contact us site map q's testimonials disclaimer links online doctors why generic drugs.
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Cozaar may interact with medications such as rifampin, additional blood pressure medications, diuretics, celecoxib, fluconazole, aspirin, or nsaid pain relievers and itraconazole. Finding is also noted in vitro in cultured endothelial cells in response to oxidized LDL. The results indicated that this is the case. It is possible that in the early stage of atheroma formation, MCP-1 elaborated by the cells in the vascular wall may be important for the monocyte macrophage accumulation in the intima. Monocyte-derived macrophages and smooth muscle cells are capable to express MCP-1 mRNA.27, 28 Increased MCP-1 expression in the WHHL aorta with aging may be attributable to macrophage infiltration in the intima. MCP-1 exerts its chemotactic effects on monocytes in circulating blood through specific cell-surface receptors. Thus, it is not possible to know whether the increased MCP-1 protein expression in the aorta of WHHL is the cause of the regional difference in atherosclerosis or simply the result of the process. Nonetheless, our finding on the regional difference in MCP-1 mRNA and protein expressions between the aorta and the carotid artery of WHHL may be important to warrant a caution when examining atherogenic genes using microarray methods, for example, fluconazole ringworm.

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To amphotericin B for patients with impaired renal function. It is not removed by haemodialysis. Although cerebrospinal penetration is poor, reports of therapeutic efficacy in CNS mycoses have appeared[36, 37]. Indications: Under FDA review for oral treatment of aspergillosis, zygomycosis and fusariosis in patients refractory or intolerant to other therapies. It has also been used in Fusarium keratitis. Recently has been approved as prophylactic agent for invasive Aspergillus and Candida infections in severely immunosuppressed patients, such as hematopoietic stem cell transplant recipients with graft-versus-host disease and those with prolonged neutropenia. Dosage: Oral route: adults: 200 mg q6h or 400 mg q12h. It should be administered after meal. Children doses are not yet established. RAVUCONAZOLE AND ALBACONAZOLE Ravuconazole Bristol-Myers, Squibb Inc, CT, USA ; exhibits potent in vitro activity against Candida spp., Aspergillus spp., C. neoformans, H. capsulatum and C. immitis. Cross-resistance between fluconazole and ravuconazole was observed with C. glabrata and is variable among other Candida spp. Ravuconazole is less active than voriconazole against Fusarium, Scedosporium and Trichosporon spp., and it has no activity against Rhizopus or Mucor spp. Immunosuppressed animal models have confirmed efficacy against Candida spp., Aspergillus spp., and H. capsulatum [38, 39]. Metabolism is primarily hepatic. Ravuconazole is well-tolerated in healthy adults. Drug interactions are uncommon. Ravuconazole and albaconazole are undergoing early clinical evaluation and their future is uncertain. For all newer triazoles, concerns about emerging drug-resistant fungi and the incidence and management of breakthrough infections will dictate their role in antifungal prophylaxis and treatment. ECHINOCANDINS The echinocandins are a novel class of agents that irreversibly inhibit [beta]-1, 3-D-glucan synthase, the enzyme complex that forms glucan polymers in the fungal cell wall, but is absent in mammalian cells. They are active against Candida, Aspergillus, but not against Cryptococcus, zygomycetes and some other moulds. Interestingly, echinocandins are fungicidal against yeasts and fungistatic against moulds. Their limited toxicity and minimal drug-drug interactions make them an attractive option for treatment of invasive mycoses. Currently, these intravenous agents include caspofungin Cancidas, Merck Research and kamagra.
Therapeutic efficacy is judged by seizure control and the appearance of toxic effects. Asymptomatic patients do not require regular blood tests if initial screening tests were negative. 23 Laboratory tests should be performed only when indicated. For example to help determine compliance in a patient with poor control or to review drug levels in patients with altered pharmacokinetics ; . Routine blood tests are ineffective in preventing serious toxicity.23, 24 Drug levels should be interpreted with caution. Diagnosis of drug-induced side-effects is based on clinical features. Some patients may have side effects even at low dose of AED, for instance, fluconazole cream.
On diabetes for both the healthcare professionals and the people with diabetes in Rwanda. Furthermore, the quality of communication between physicians and people with diabetes is poor. Sadly, this scenario provides the ideal setting for an increase in the risk from diabetes and diabetes complications in people in Rwanda. The capacity of the Association Rwandaise des Diabtiques to respond to the diabetes training needs in Rwanda is limited. Fraternit published a leaflet providing basic information, which was distributed free of charge to hospitals, dispensaries, and health centres. Though tiny in comparison with the wide-scale solutions that are urgently required at all levels and in all sectors of healthcare in Rwanda, such awareness-raising initiatives are effective in saving the lives of people who otherwise might not have their symptoms recognized due to the lack of diabetes awareness in the country. Access to diabetes supplies The most acute of the difficulties faced by people with diabetes in Rwanda is the lack of access to lifesustaining medication. Despite the classification of insulin by the World Health Organization as an essential medication, for much of the diabetes population in Rwanda access to the drug is severely limited. For many people with diabetes, a trip to the pharmacy, the only place insulin can be purchased, might require a journey of a day or more. Furthermore, due to the common difficulties with the distribution, storage, and transportation of medical supplies in Rwanda, the pharmacies themselves often lack necessary diabetes supplies, such as strips to test levels of glucose in the urine essential in the detection and management of the condition. In Rwanda, the widespread poverty of the population represents a major risk to health. The excessive cost of insulin and diabetes supplies to people with the condition remains a major threat to the health of most people with diabetes in the country. The excessive cost of insulin and diabetes supplies is a major threat to the health of most people with diabetes in Rwanda. access to diabetes supplies for people with diabetes in Rwanda through partnerships with organizations such as Insulin for Life, Australia and the IDF Child Sponsorship Programme. Conclusion The International Diabetes Federation IDF ; has initiated a programme which is potentially of great benefit to people with diabetes in Rwanda. In order to initiate and implement projects to improve access to insulin and diabetes supplies, the Federation mediates in partnerships between IDF Member Associations in developed countries and selected Associations in developing countries. For more information on how the diabetes association in your country can assist people with diabetes in Rwanda and other poor countries, please visit the insulin section of the IDF website at idf insulin. A future must be envisaged for Rwanda in which the chronic damage done to the fabric of Rwandan society is repaired through the collaborative efforts of all sectors of the population, supported by resource-endowed external backers and investors. The Association Rwandaise des Diabtiques seeks partnerships with diabetes organizations, other non-profit organizations and private-sector companies to collaborate with us to improve the life of people with diabetes in Rwanda. y Franois Gishoma and ketoconazole. Accuracy The accuracy of the NCN CRLstatTM Monitect 7 Multi-Drug Screen Panel was evaluated in comparison to the results from GC MS analysis or predicate method using commercially available immunoassay. 40 presumed negative urine samples were collected from volunteer donors and tested with both the NCN CRLstatTM Monitect 7 Multi-Drug Screen Panel and the predicate method. Of the 40 presumed negative urine samples tested, all were found negative by both methods 100% agreement ; . Additionally, for each drug test, a minimum of 40 clinical urine samples previously analyzed by GC MS method with known concentration s ; of drug s ; were blind labeled and evaluated. The results are summarized below.

Main page faqs contact us f-con cipla f-con forcan, fluconazole, diflucan to also abdomen and lamisil. David simmons, fracp, md, professor of medicine. Clinic for Ruminants, Department of Clinical Veterinary Medicine; Department of Veterinary Pharmacology, University of Berne; Dr E. Graeub AG, Berne, Switzerland and lansoprazole and fluconazole, for instance, how long does it take for fluconazoe to work. The metabolism of repaglinide may be prevented byketoconazole nizoral ; , itraconazole sporanox ; , fluconazoole diflucan ; , erythromycin ery-tab ; , andclarithromycin biaxin.

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Technical Cut-Off: Based on the reproducibility of the assay at a 95% CI. Clinical Cut-Off: Based on the correlation between phenotype and virological responses. * Treatment-Nave Range TNR ; : Upper limit of the range of drug susceptibilities seen for the virus from a panel of treatment-nave subjects, used if clinical cut-off unavailable. * : Ritonavir is no longer prescribed for its own antiviral activity, but as a pharmacological enhancer for the other PIs. Patient Resistance Index: The fold-difference in drug susceptibility between the tested virus and the drug-sensitive control virus tested in parallel. Est. Contribution to Response: Likelihood that this drug will be effective as based on the patient resistance index value. Likely: Values below the technical cut-off indicate that the tested virus is not different from the drug-sensitive control virus.

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FLUCONAZOLE CAPSULES 200MG FLUCONAZOLE GOLGI CAPSULES 150MG FLUCOZAL CAPSULES 100MG FLUCOZAL CAPSULES 150MG FLUCOZAL CAPSULES 200MG FLUCOZAL CAPSULES 50MG FLUDARA VIALS 50MG FLUDEX TABLETS 2.5MG FLUIBRON SYRUP 15MG 5ML FLUMETOL A EYE DROPS FLUOCIM CAPSULES 20MG FLUOROURACIL INJECTION 25MG ML, 10ML VIALS FLUOXETINE CAPSULES 20MG FLUOXETINE GOLGI CAPSULES 20MG FLUPHENAZINE DECANOATE INJECTION 25MG ML, 1ML FLUROFEN SUGAR COATED TABLETS 100MG FLUROZIN SUGAR COATED TABLETS 100MG FLUROZIN SUGAR COATED TABLETS 50MG FLUSEMINAL FILM COATED TABLETS 400MG FLUTAN TABLETS 250MG FLUTAPLEX TABLETS 250MG FLUVIRIN LIQUID 15MCG 0.5ML FLUXIL CAPSULES 20MG FML-NEO EYE SUSPENSION FOLICIL TABLETS 10MG FOLIFER TABLETS FORADIL CAPSULES 12MCG FORANE LIQUID 100ML FORCEVAL CAPSULES FORCEVAL JUNIOR CAPSULES FORCEVAL PROTEIN NATURAL, STRWBERRY, VANILLA ; POWDER FORD PILLS WITH SENNA TABLETS FORTA B12 INJECTION 4MG ML, 3ML AMPS FORTANEURIN INJECTION FORT-E-VITE CAPSULES 1000IU FORT-E-VITE PLUS SOFT GELATIN CAPSULES 200IU FORTOVASE SOFT GELATIN CAPSULES 200MG FOSAMAX TABLETS 10MG FOSAMAX TABLETS 70MG FOSTIMON HP INJECTION 150IU WITH SOLVENT FOSTIMON HP INJECTION 75IU WITH SOLVENT FOTOTAR CREAM 2% FRAKIDEX EYE DROPS.
It is ironic though that every day millions of children line up to the counter for their dose of meds while the person caught in possession of these drugs without a prescription face felony charges, for instance, fluconaole nasal. Apo ® -fluconazole is available in strengths of 50 mg and 100 mg and galantamine.

Yao YF, Zhang YM, Zhou P, et al.: Therapeutic penetrating keratoplasty in severe fungal keratitis using cryopreserved donor corneas. Br J Ophthalmol 2003, 87: 543547. In this retrospective consecutive case series of 45 patients with severe fungal keratitis, grafting with cryopreserved cornea seemed to have yielded excellent results, in spite of the use of topical and oral fluconazole perioperatively, in the knowledge that fluconazole is supposed to be not effective against Fusarium and Aspergillus species. For purposes of parenteral administration, solutions of the compounds in sesame or peanut oil or in aqueous propylene glycol may be employed, as well as sterile aqueous solutions of the corresponding pharmaceutically acceptable salts. B 5.5.1 Purchase of a bench top steam steriliser Those involved in the purchase of equipment should refer to MDA DB 2002 06 ; 42 and must obtain the supplier's assurance that the steriliser is suitable for the loads that the user intends to process, because some machines have limited function. For advice contact the Infection Control Team, an Authorised Person sterilizers ; contact details available from PASA pasa.nhs ; or Strategic Health Authority Decontamination Lead. The processing of wrapped instruments and utensils, instruments with lumens and the processing of porous loads cannot be carried out in standard bench top steam sterilisers. Items such as these must be processed in a vacuum, or porous load, steriliser that the manufacturer has validated for this type of load. B 5.5.2 Installation and commissioning of a bench top steam steriliser42 After a steriliser has been installed, it must be checked and tested commissioned ; by a properly trained and qualified test person who may be employed by the manufacturer or a contractor. These checks and tests are intended to demonstrate that the steriliser functions correctly and complies with the specification. The test results must be recorded in the steriliser logbook. A steriliser that has not been commissioned, or fails any test during commissioning, or periodic testing, must not be used until the cause has been identified and corrected. It must then be fully re-tested and fulfil all test requirements satisfactorily before being used. B 5.5.3 Logbook42 Each steriliser must have its own logbook, which provides a permanent record of all testing, maintenance and repairs performed on the steriliser. It must contain a record of all actions taken in the event of a failed cycle or a failed test. The logbook may provide useful evidence in a case of litigation. B 5.5.4 Testing and Maintenance42 The owner user is responsible for daily weekly testing, which are designed to show that the operating cycle functions correctly. See Table 5. Record all observations in the logbook. An independent recording device can be fitted to some types of steriliser and will provide a permanent record that can be kept in the logbook. The observed values must be within the established timetemperature limits for the cycle. A more comprehensive description is given in MDA DB 2002 06 ; . A Test Person sterilisers ; must conduct quarterly and annual testing. Owners of bench top steam sterilisers must ensure that the steriliser is subject to a planned and documented schedule of preventative maintenance. The manufacturers will also advise on these aspects. HTM 2010 Part 3 provides comprehensive information on all aspects of testing bench top steam sterilisers.
Other oral azole agents such as ketoconazole and itraconazole have been shown to be as effective as topical agents; one advantage is ease of administration but the potential for toxicity, particularly adverse hepatic effects, should be considered. C. Follow-up Patients with frequent or chronic candidal vulvovaginitis may be more difficult to treat; they should be evaluated for predisposing conditions especially HIV infection and diabetes ; see section F ; . D. Counseling Patient Education Patients should: 1. Understand how to take or use medications. 2. Return for evaluation if symptoms persist or recur after treatment, and 3. Understand that many yeast creams are oil-based and may break down latex condoms. E. Evaluation of Sex Partners Treatment of sex partners is usually not necessary unless candida balanitis in the partner is present. F. Recurrent Candidiasis Defined as four or more recurrences per year. Due to poor accuracy of selfdiagnosis confusion with other causes of vaginitis ; it is recommended that recurrences be clinician diagnosed. First try a longer duration of initial therapy before initiating a maintenance antifungal regimen 7-14 days of topical therapy or a repeat dose of fluconazole at day 3.

Medications that are known to interact with biaxin include heart rhythm medication, medicine that weaken the immune system, hiv medications, sedatives, seizure medications, cholesterol lowering drugs, viagra, theophylline, rifabutin, tritec, fluconazole, omeprazole, bromocriptine, and cilostazole.
OL of Care KEY: OR GREE KEY GRE , 1 2 1 Follow EN I 008 ; 08 ; nk ing Inpatie 1 RED Ink OASI RE O Items Ink nt Stay ; BLAC BLA D Ink ASIS Items CK I Specif Items Spec Hometo be used Ink nk 10 ; ific 485 0 ; Agenc i P PAT Agen Additiofic 485 Items specif Health at this Time Addit pecific IENT cy Medic ATIEN tional Items comp PPS P i nal ic 485 Patien Medi Point: Com Comp completedPS Indica I TRA care Items are Provid T TRA Items t Track Item prehens leted p ndicators Prov rehen to CKIN CKIN t ing Sheet ider M001 M00 sive Asseser agenc ors er Numb M083 be used at this ive A per agen G SH Num 12 ; 2 ; A sses c po SHE Date: 0-M0 ber: , M008 er: Agenc EET smen genc sment y policy ; l ET 880, Time Point: y Me t Items icy ; 0-M08 Medic Items M090 Fill O Fill Out dicai ASSES aid P 26 additi d Provid 3-M0 M0080-M0 SMEN ut at rovid at S IN: 906 onal T TIME er Numb er Nu Star 100, tart and Disch M020 Comp mber 20 ; OUT er: 0 ; Patient o Care of : rehen Patie : 0-M0 arge nt 7 Provid f Care a sive Prov Summ 220, nd Asses ider Name, and U er Na M025 ary smen pdate me, Addres Upda 0, M028 Addr te per t Items ess and 0-M0 and Teleph per Ag and Age n Period No. No. Perio Telep 380, ency M00 M001 d hone M041 one Numb ncy P 14 ; Branch Polic 4 ; B Num olicy 0-M0 ranch ber er 6 M 820, M004 State State 0040 ; 0 ; Patien Patie M00 M001 nt Name To: To: 16 ; Branch o Nam 6 ; B e: First ; ranch Patien Patie Firs Fi t ir ; Numbe nt St Street mb mber reet Addres Addr ess MI ; MI ; MI ; M006 M00 M003 M00 0063 ; 0063 32 ; 06 ; 2 ; Resum 2 M003 M00 Resu Medi HI Claim Medic 030 ; mption mpti mpti dic dicar 30 ; ic month ; Sta Start monthtion of Care of Ca No. are Numb No Num rt of h Date: ber: Care er: includi Da e: City City inclu day are Date: day day re Dat ity t Las Last ; da day te: ay ding e: OM ng suffix, y ffix, i fi if 8 M006 ix f M00 any ; any ; ye year year 66 ; ye 6 ; Birth NA NA Birth year year NA NA Not Applica Not A Date Date: pplic No M No Medica : month able ble edica M00 M006 mon 24 Pr 24 Primar re re 64 ; Suff Suffix th 4 ; Social M00 M005 imary ffix ; Socia fi ix 50 ; day day Phys Physic l Securi Secu of Re 0 ; Patie of Reside Patien Patie Patien ician ia ian s rity Numb sidence: nt State ty Nu nt State Addres Addr Nam Name Phone nce: year year mber: one # e ess er: M00 M006 60 ; 0 ; Patien UK UK 9 M006 - Patie M00 M00 M006 Unknow Unkn Physic Phys nt Zip 0 9 Zip Code: M00 M006 o ician ; Ge Code ian s Not Availab Not Av wn or Male 9 ; Gende 65 ; 5 ; Medic nder: : Phon Phone ailab Medi r: e le caid aid Numb Num 2 - Female M014 M01 Fema M00 M007 ber: er: Effec 40 ; Race le 0 ; R Prima Effective tive D Prim a E rim rima i ry Emer Emerg 1 - Americe Ethnic ate: thnic ry Referr Date: A Refe gency ency ity it NA - No Medica 2 - A merican Phys Physic rring ing Physic Cont Contac No Medic Asian can Indian y as identif ician India as ident Phys ian s act Name id n or Alaska ified by Nam M01 M015 sian ician aid ied b Fax Fax or Al ian ID: e 50 ; Cu ID: y Addres Addr aska 0 ; C Curren ess u Native patient ; : Nativ patient ; : 0 - None; rrent P UK e Mar Mark Payme Unkn Unkno k all 1 - M o ayment S own Re Relat Relatio 3 - Black all that wn or Medic Medi no charge nt Sourc Black that apply. or Not ionship Secon Seco apply nship 2 - M edicare harge for ources fo Not Availa are tradit for es for 4 H y. ; ndary or Medic dary Avail t di edica curren Hom ispanor African ; Phys Physic able are Hraditional current se r Home Care: - Hispanic African-Amer ble re HMO ional f ic or ician ian s MO manafee-for services e Care: or Latino merican Latin A ican man ee-for-se rvices Nam Name Mar Mark Phon Phone o aged -servic rvic e ka ge all e 3.

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